Residence

Business

Please describe the nature of the industry you are in and give a brief history of your car

Previous Employer

Previous Employer

Title

Previous Employer Dates

Previous Employer Address

Previous Employer Telephone

Family Information

Marital Status (Marriage Certificate Required)

Married

Single

Date of Marriage

List of Family Members

Spouse Birth Date (If applicable)

Will your spouse be participating in

Tennis

Social

Both

No

Spouse Birth Date (If applicable)

Spouse Place of Birth (If applicable)

Spouse Occupation (If Applicable)

Spouse Company

Spouse Years with Company (If Applicable)

List of Family Members

Financial and Credit Information

Tennis Related Information

How long have you played Tennis?

What is your Tennis Rating?

3.0

3.5

4.0

4.5

5.0

5.5

n/a

Purpose of Tennis

Please list the membership (present and past) in other country, tennis, sports, social or recreation clubs and the dates of membership

Same Questions for Spouse

Have you ever applied for (or been proposed) and not accepted into membership of any club

By my signature below, I hereby acknowledge that my name has been submitted for membership in The Riviera Tennis Cluband that all information on the Request for Proposal and Proposal forms is correct and factual.

I understand that membership is The Riviera Tennis Club is non-participatory (non-equity) and is non-transferable and non-refundable. If accepted into membership, I will incur no liability for the debts of The Riviera Tennis Club, either past, present or future; neither do I acquire any property rights in the assets of The Riviera Tennis Club. I also agree to abide by the By-Laws and House and Grounds Rules as they now exist or may hereafter be amended.

I hereby authorize the disclosure and release of any personal or financial information, under The Fair Credit Reporting Act to The Riviera Tennis Club executive committee in the evaluation of my proposal for membership. I also authorize The Riviera Tennis Club to contact my references and allow them to disclose information such as may be requested.

I understand that if this proposal is not acted upon facorably within 180 days of receipt by The Riviera Tennis Club, I may consider it no longer under active consideration. I also understand that The Riviera Tennis Club does not discriminate on the basis of sex, race, color, religion, ancestry, national origin, disability or sexual orientation.

I understand that the membership proceedings shall be confidential. I understand that any material misrepresentation or omission in the Memberhsip Proposal is grounds for termination.

* Bold Fields are Required

The Riviera Country Club • 1250 Capri DrivePacific Palisades, California90272